Consultation on the Functional Assessment of Students with Severe Challenging Behavior in a Japanese Special School for Intellectual Disabilities

Long-Term Outcomes for a Student with Severely Challenging Behavior in a Special Needs School for Intellectual Disabilities: A School Consultation Case Study

Self-injurious, stereotyped, and aggressive/destructive behaviors exhibited by individuals with intellectual disabilities and autism spectrum disorders are called challenging behaviors (CBs). Severe CBs often require long-term treatment involving psychosocial approaches based on behavioral interventions and/or medication. A boy with severe CB enrolled in a special needs school, with diagnoses of autism and intellectual disability, was the client of the study. This case report describes the long-term outcomes of eight years of continuous school consultation. The student's severe CB improved with environmental adjustments in the classroom, unified teacher involvement, instruction of leisure and communication skills, and medication. Long-term research on changes in CBs through school consultation is limited, and this case report provides important insights into the development of effective educational programs and curricula for severe CBs in school-aged children.

Assessment of Challenging Behavior Exhibited by People with Intellectual and Developmental Disabilities: A Systematic Review

The assessment of challenging behavior exhibited by people with intellectual and developmental disabilities is essential for the planning of prevention and intervention programs. This review aimed to identify and analyze the standardized instruments that exclusively focus on the assessment of challenging behavior. We identified and organized 141 articles into four categories: original instrument studies, validation studies, relational studies, and intervention studies. The results identified 24 instruments that generally show high-quality psychometric properties and other utilities beyond the observation of the presence of challenging behavior and diagnostic categorization. Age, level of adaptive behavior, disability, presence of autism spectrum disorder, and medication are some of the variables that were found to be possibly related to the occurrence of challenging behavior. Additionally, the results suggest that interventions focused on supporting positive behavior or providing training on behavior to professionals and caregivers significantly reduced the occurrence of these behaviors. Instruments that help us to understand and measure the challenging behavior exhibited by people with intellectual and developmental disabilities are essential for the design of effective evaluation and intervention protocols.

Reducing challenging behaviours among children and adolescents with intellectual disabilities in community settings: a systematic review of interventions

Background: Challenging behaviours are common among children and adolescents with intellectual disabilities. Such behaviours often result in poor quality of life outcomes such as physical injury, difficulties with relationships and community integration. Aim: This systematic review aimed to synthesise evidence from studies that assessed the effect of interventions used to reduce/manage challenging behaviour among children with intellectual disabilities in community settings. Methods: Studies published between January 2015 and January 2021 were sought from five electronic databases. The quality of studies was assessed, and a narrative synthesis was conducted. Results: A total of 11 studies were included which utilised various non-pharmacological interventions including multi-model interventions, microswitch technology, cognitive behavioural therapy, art, music and illustrated stories. Microswitch cluster technology was the most used intervention. Studies using pharmacological interventions were not retrieved. Results indicated that a person-centred planning approach was key to offering individualised treatment. Conclusions: The superiority of one intervention or a combination of interventions could not be determined from this review given the heterogeneity of studies. Future research is required to explore the use and effects of pharmacological interventions to compare outcomes and improve quality of care of children with intellectual disabilities.

Interventions for Students with Problem Behaviors: A Workshop Incorporating Applied Behavior Analysis for Japanese Teachers

Background

We conducted a workshop-style program based on applied behavior analysis (ABA) for Japanese teachers in charge of children with developmental disabilities who had behavioral problems. Additionally, we investigated whether making and implementing behavioral intervention plans (BIPs) for participants, improved students' behavioral problems, and the mental health of participants.

Methods

The participants were 18 Japanese elementary and kindergarten teachers in charge of students with behavioral problems. The workshop comprised eight two-hour sessions of lectures and group discussions related to ABA. Achievement level was evaluated for the development and implementation of the BIP and improvement of behavioral problems. In addition, we analyzed changes in the 30-item General Health Questionnaire (GHQ-30) scores pre- and post-workshop to assess participants' mental health. Fifteen teachers who participated in more than half of the sessions were analyzed.

Results

All 15 teachers analyzed were able to perform appropriate functional behavioral assessment (FBA) and make a BIP, and 12 showed improvement in the targeted problem behaviors. Many target behaviors had avoidance functions and many antecedent strategies were behavior contracts. Adaptive behaviors incompatible with problem behaviors were selected as alternative behaviors to problem behaviors. Also, there was no aversive control over the outcome strategy. The average score for "social activity disorder" and "anxiety / caprice" in GHQ30 showed a statistically significant improvement in pre- and post-workshop.

Conclusion

It was found that appropriate FAB and BIP could be created using "the strategy sheet," in workshops based on the ABA. It was also suggested that the workshop program may in turn improve teachers' mental health. Further study is needed on the effectiveness of the workshop program using intergroup comparison designs for more subjects.